Education and implementation of the clinical opiate withdrawal scale (COWS) in the acute care setting for care providers.

The opioid epidemic is a growing crisis, the US consumes a majority of the worlds opioid supply. There are an estimated 100,000,000 opioid dependent persons and according to the National Institute of Health (NIH) over 7 million of those individuals also have an overlapping mental illness which further complicates treatment for this population. In the inpatient setting there is a great need to assess the opioid dependent patient and identify withdrawal signs and symptoms. There are many challenges especially within the ICU when recognizing these patients. Patients can require mechanical ventilation and intravenous sedation and pain medication which consist of opioids. This can have grave consequences on the health of these patients as well as the ability of the healthcare provider to provide appropriate, adequate and affordable care. Recognizing the need for an accurate and targeted tool for the healthcare provider has become vital in the management of these very complex individuals. The clinical opiate withdrawal scale (COWS) assessment tool which has been previously recognized as a reliable tool of opiate withdraw was introduced to the staff of various ICUs. Staff were surveyed both before and after the introduction of this tool and analysis was performed to assess both understanding of the tool as well as comfort level utilizing the tool